Effectiveness of a social justice curriculum intervention on cultural competency among internal medicine residents.

Abstract

There is a nationwide need to include social justice topics in medical education to reduce health disparities of culturally diverse patients. Cultural competence and humility act as a link between historically marginalized racial and ethnic groups and social justice to foster health equity among patients. We implemented a Social Justice in Medicine curriculum in the Internal Medicine residency program to prepare cultural competencies for social justice among residents. We sought to investigate the impact of curriculum implementation on residents' cultural competency. The social justice in medicine included a variety of educational strategies including online curriculum modules, immersive clinical experiences in continuity clinics, community engagement, a lecture series (Social Determinants of Health, social injustices, resident activism, etc.), and the use of reflective practices (bias assessments, group discussions). We conducted a pre-post quasi-experimental study (July 2023-June 2024) to evaluate the effect of implementation of an educational intervention on competency as measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised, a 25-item four-point Likert scale. This instrument assesses cultural awareness, knowledge, skill, encounters, and desire. The effect size was summarized with mean difference (MD) and 95% confidence interval (CI). A total of 40 residents participated in the study. Overall 11.7% relative improvement in cultural competency was observed following the intervention (MD = 7.7; 95% CI: 4.72-10.68, p < 0.001). The intervention improved all the domains of competency including awareness (MD = 0.93; 95% CI: -0.02-1.87, p = 0.05), knowledge (MD = 2.20; 95% CI: 1.33-3.07, p < 0.001), skill (MD = 1.90; 95% CI: 1.12-2.68, p < 0.001), encounters (MD = 1.10; 95% CI: 0.23-1.97, p = 0.014), and desire (MD = 1.58; 95% CI: 0.80-2.35, p < 0.001). The implementation of social justice in the medicine curriculum improved the cultural competencies among internal medicine residents in our study. Future longitudinal studies are required to investigate challenges, barriers, and modes of implementation strategies in a larger setting.